Biopsy device having endoscope

ABSTRACT

A biopsy device having an endoscope comprises a biopsy instrument, suitable for collecting at least one tissue sample from a body lumen, such as a mammary duct, and a cutter introducer sized for receiving the biopsy instrument and introducing the biopsy instrument into a mammary duct to retrieve a tissue sample therefrom.

RELATED APPLICATION

This application is a continuation-in-part of application Ser. No. 10/422,381, filed on Apr. 24, 2003.

TECHNICAL FIELD OF THE INVENTION

The invention generally relates to a device for obtaining mammary duct tissue samples for analysis. More specifically, the invention relates to a biopsy device having an endoscope and an introducer therefor.

BACKGROUND OF THE INVENTION

Breast cancer is one of the health threats most feared by women, and is indeed the most common form of cancer in women. A key to treatment is early detection. For example, an annual mammogram is a method that has been used in hopes of early detection of breast cancer. One problem with mammography is that such an imaging technique can only find breast cancer once it has taken form. All too often, breast cancer is discovered at a stage that is too far advanced, when therapeutic options and survival rates are severely limited. While breast cancer is most common among women, in rare instances the human male may also have occurrences of breast cancer.

Other methods of detecting breast cancer are based on the fact that in a vast majority of instances breast cancer begins in the lining of mammary ducts. Studies have shown that fluid within the mammary duct contains high levels of breast cancer markers, and that an estimated 80%-90% of all breast cancers occur within the intraductal epithelium of the mammary glands. Fluid within the breast ducts contains an assemblage and concentration of hormones, growth factors and other potential markers comparable to those secreted by, or acting upon, the surrounding cells of the alveolar-ductal system. Likewise, mammary fluid typically contains cells and cellular debris or products that can also be used in cytological or immunological assays. As such, techniques such as ductal lavage, collection of mammary duct discharge, and brushing biopsies have been utilized to obtain such samples for diagnostic purposes.

If suspicious tissue is located, a biopsy of the tissue may then be taken. One biopsy device that has been utilized is the Mammotome® biopsy system available from Ethicon Endo-Surgery, Inc., Cincinnati, Ohio. After mapping an area to be biopsied, the Mammotome® probe, a needle-like device with a hollow passage therethrough, is introduced through an incision cut into the breast and inserted further until the desired biopsy region is accessed. When the probe is positioned at the region of concern, tissue is received into a window in the probe with vacuum assist. A cutter then cuts and removes tissue samples for examination. The samples are passed through the hollow passage of the probe into a collection chamber. Because the Mammotome® probe is directional, multiple specimens can be collected without having to remove and reinsert the device. The Mammotome® probe is removed after the samples have been collected, and the incision is closed.

Such a system significantly decreases the invasiveness of the biopsy procedure by only requiring a small incision and puncture, which may be done under local anesthetic. However, in certain situations, such as where the tissue to be biopsied is in a mammary duct, the incision and probe insertion required with the Mammotome® is unnecessarily invasive and undesirable.

What is needed is a biopsy device for conducting a minimally invasive biopsy procedure without the need for an incision. It is also desirable that the physician be able to take multiple tissue samples from a single biopsy site. It is further desirable for the physician to be able to identify and record the location of each sample of tissue extracted. The present invention meets the foregoing desires and provides an improved device for taking a biopsy within a mammary duct, as well as a device that facilitates memorializing in the patient's records the location of the tissue sampled.

SUMMARY OF THE INVENTION

A biopsy device embodying the present invention comprises a biopsy instrument provided with a tissue cutter suitable for collecting at least one tissue sample from a body lumen, such as a mammary duct, and a cutter introducer sized for receiving the tissue cutter and guiding the tissue cutter into a mammary duct.

The biopsy instrument includes a holster, a housing reciprocably mounted in the holster, and an elongated hollow cutter that extends from the housing and is driven by a cutter drive motor situated within the housing. A power connector, operably connected to a power source, is associated with the cutter drive motor. The hollow cutter rotates about a longitudinal axis thereof upon energization of the motor by activating a switch operably associated with the motor. The hollow cutter also extends distally relative to the holster when the housing is urged into the holster. An ejector assembly is removably mounted to the housing and received within the cutter. The ejector assembly includes an endoscope which is slidably received within the hollow cutter and may be extended therethrough. The endoscope serves the dual purpose of viewing the area to be biopsied, as well as serving as a piston for urging or expelling biopsied material from the cutter. A coupling mount for removably receiving the cutter introducer, such as a boss terminating in a distal, radially outwardly extending flange, is also provided on the biopsy cutter.

Preferably included within the housing is a power source, such as a battery, which can be a primary battery, i.e., single use, or a secondary battery, i.e., rechargeable. Alternatively, the power source may be external to the housing and the holster therefor, but operatively connected to the power connector. The housing and holster are preferably formed of a lightweight rigid plastic. The cutter is preferably formed of a lightweight metal such as stainless or surgical steel, or the like.

The other component of the biopsy device is the cutter introducer, which is comprised of a hollow handle, and an elongated sheath having open opposite ends, i.e., a distal end and a proximal end, mounted to the handle and adapted to receive the cutter element therewithin. A window cut-out or aperture is provided at a distal end portion of the sheath. The window or aperture preferably includes a hook portion for grasping and pulling the target tissue through the window and into the sheath. A proximal end portion of the sheath is fixed within the handle. The hollow handle further defines an axial passage leading to the sheath.

The handle of the cutter introducer preferably includes an integral azimuth indicator, which may be unitary with the handle. The azimuth indicator can also be a pair of azimuth indices that can be aligned vis-a-vis one another, and the like. The handle can also include a socket for receiving the coupling mount of the biopsy instrument. For example, the coupling socket on the handle may be an annular cavity which can receive the boss of the holster provided with a radially outwardly extending flange. The handle is also preferably formed of a lightweight rigid plastic. A tissue anchor extendable through the introducer is desirable in some cases. The tissue anchor can comprise a hollow hub and flexible outwardly biased tines that extend from the hub and an optional retriever rod. The tissue anchor is slidably and rotatably mounted within the sheath at the distal end portion thereof. The tines of the anchor are extendable from the open distal end of the sheath and spread radially outwardly when so extended. A distal end portion of the retriever rod, which retracts the anchor and the tines within the sheath, is configured to engage the anchor.

In order to obtain a tissue sample with the biopsy device from a mammary duct the cutter introducer is first inserted into a nipple orifice at the nipple surface and then advanced into the mammary duct. The endoscope may be utilized within the introducer to locate and view the biopsy site, if desired. When a tissue mass of interest is located, and the distal end portion of the sheath positioned as desired, the tines of the anchor are extended beyond the open distal end by urging the hub of the tissue anchor to slide towards the distal end. The tines are pushed through the open distal end, and because they are outwardly biased, spread out radially to contact the walls of the mammary duct and immobilize the introducer.

The biopsy instrument, in particular the cutter, is inserted into the introducer and extended towards the distal end portion thereof. A tissue mass from the biopsy site is received within the introducer sheath through an aperture or cut-out at the distal end portion of the introducer sheath. The motor for driving the cutter element is energized and rotates the cutter element. As the distal end of the cutter travels across the aperture, that portion of the tissue mass received within the introducer sheath is severed. The biopsy instrument is withdrawn from the introducer sheath after the desired tissue samples have been taken. The hollow cutter element receives the tissue mass within its interior, and the severed tissue is later ejected from the hollow cutter by the ejector assembly for analysis.

When it is desired to remove the introducer, a retriever rod may be extended through the introducer sheath to engage the hub of the tissue anchor. The retriever rod is then retracted and draws the anchor back into the sheath, thereby disengaging the tines from the mammary duct. The introducer can then be withdrawn from the mammary duct. Alternatively, the anchor can be urged past the distal end of the introducer and left in the mammary duct as a biopsy site marker or indicator.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings,

FIG. 1 is a perspective view of an embodiment of a biopsy device;

FIG. 2 is a partial cross sectional side view of the biopsy instrument;

FIG. 3 is a partial cross sectional top view of the biopsy instrument of FIG. 2;

FIG. 4 is a cross sectional side view, partially broken, of the cutter introducer;

FIG. 5 is an enlarged cross sectional view of the distal end portion of the cutter introducer and the tissue anchor in a retracted position;

FIG. 6 is an enlarged cross sectional side view of the distal end portion of the cutter introducer with the tissue anchor in an extended position;

FIG. 7 is an enlarged cross sectional side view of the distal end portion of the biopsy introducer with the tissue anchor in an extended position and a retriever rod engaged with a tissue anchor latch;

FIG. 8 is an enlarged cross sectional side view of the distal end portion of the cutter introducer with the tissue anchor extended and engaged with a mammary duct, and a cutter within the introducer;

FIG. 9 is an enlarged cross sectional side view of the distal end portion of the biopsy introducer with an alternate embodiment of the tissue anchor in an extended position and equipped with a retriever rod suitable for engaging the tissue anchor;

FIG. 10 is a schematic of a human breast having the biopsy device inserted therein, and an azimuth marker circumscribing a breast nipple;

FIG. 11 is a cross sectional side view of another embodiment of a biopsy device with an ejector assembly comprising an endoscope which is shown in an extended state;

FIG. 12 is a cross section side view of the biopsy device of FIG. 11 with the endoscope in a retracted state;

FIG. 13 is a perspective view of another embodiment of a biopsy device having an endoscope;

FIG. 14 is an enlarged cross sectional view of the distal end portion of an embodiment of the biopsy device having a hooked window portion; and

FIG. 15 is an enlarged cross sectional view of the distal end portion of an embodiment of the biopsy device taking a core tissue sample.

DESCRIPTION OF THE PREFERRED EMBODIMENT OF THE INVENTION

The invention disclosed herein is susceptible of embodiment in many different forms. Shown in the drawings and described hereinbelow in detail are preferred embodiments of the invention. It is to be understood, however, that the present disclosure is an exemplification of the principles of the invention and does not limit the invention to the illustrated embodiments.

A preferred embodiment of a biopsy device is shown in FIG. 1. Biopsy device 10 is comprised of a biopsy instrument 12 and a cutter introducer 14 removably carried by the biopsy instrument 12 and having hollow elongated sheath 26 mounted to handle 24. The biopsy instrument 12 comprises a holster 16, a housing 18 that is slidably and reciprocably received in holster 16, and a hollow elongated cutter 42 (FIG. 2), slidably received within elongated sheath 26 of cutter introducer 14. The elongated cutter 42 is driven by cutter motor 38 (FIG. 3) within housing 18. An end cap 22, removable to access various components within the housing 18, seals the proximal end of housing 18. An on-off switch, such as button switch 45 for energizing cutter motor 38 extends from the cap 22. Elongated sheath 26 has open opposite ends, i.e., a distal end 28 and a proximal end that is mounted to handle 24. A cut-out or aperture 30 is provided at a distal end portion 32 of the sheath 26. Depth indicators 35, axially spaced from one another can also be provided on sheath 26, if desired. Handle 24 is adapted for rotatable as well as removable mounting to housing 18, and includes a pair of integrally formed azimuth indicators, in particular, distal indicator 34 and proximal indicator 36, that are axially aligned with one another.

The cutter or blade 42 is configured for sliding travel through the handle 24 and sheath 26 of the introducer 14. Specifically, the outer diameter of the cutter 42 is smaller than the inner diameter of the sheath 26. The cutter 42 is also sufficiently long to extend to the distal end portion 32 of the sheath, and preferably such that when fully extended, the cutter element projects beyond the aperture 30.

As can be seen in FIGS. 2 and 3, a power connector, such as lead 40 for cutter drive motor 38 is also included in the housing 18 and is operably associated with the cutter drive motor 38 which drives hollow cutter 42 by rotating it about the longitudinal axis of the cutter introducer 14. In particular, motor 38 drives spur gear 39, which in turn is engaged with spur gear 43 secured to the proximal end portion of cutter 42. The motor 38 can be energized by any switching mechanism available in the art. For example, a two-position switch 45 can be operatively connected in a circuit between a power source and the motor 38, preferably biased in the OFF-position. Alternatively, the switch may also be formed by a battery 38 that serves as the power source and a conductive post 71 surrounded by insulated spring 68. As the housing is moved axially into the holster, battery 38 contacts post 71 to complete an electrical circuit between the motor and the battery. Thus, power lead 67, in cooperation with conductive post 71, spring 68 and power lead 40, form an electrical circuit between the cutter drive motor 38 and the battery 54. As yet another alternative, the switch and power supply can be operably connected to the motor, but situated external to the housing. For example, a foot-operated switch can be utilized in such instances.

Positioned between the distal end of holster 16 and distal end of housing 18 is a return spring, such as coil spring 56. The holster 16 further defines a groove 58 through which dorsal post 60 is positioned and extends therethrough from housing 18 (FIG. 2). The ventral post 60 within the groove 58 serves as a stop to limit the longitudinal movement of the housing 18 relative to the holster 16, as well as to prevent rotational movement of the housing 18 relative to the holster 16.

Coil spring 56 is axially aligned with the cutter 42 in holster 16, through which cutter 42 is extended for axial reciprocation within elongated sheath 26. A hollow support or bearing 70 may also be provided within the holster 16, through which cutter 42 passes. Also provided by the holster 16 is a coupling mount 48 for removably attaching the biopsy instrument 12 to cutter introducer 14. The coupling mount 48 is preferably a boss 49 terminating in a distal, radially outwardly extending flange. Coupling mount 48 may also include an o-ring seal 51 that circumscribes boss 49.

A pusher rod assembly 46 includes elongated piston rod 62 and an actuator handle 63, and is removably mounted within the housing 18. The piston rod 62 is slidably received within the hollow cutter 42. The pusher rod assembly 46 is slidably positioned within housing 18, and actuator handle 63 is accessible from outside the housing for manual actuation. Further disposed within housing 18 is a pusher rod coil spring 66 biased against forward axial movement of the pusher rod assembly 46. Piston rod 62 extends from actuator handle 63 into and through cutter 42. Piston rod 62 has an outer diameter that is smaller than the inner diameter of the hollow cutter 42 such that any material within the cutter 42 is pushed out by piston rod 62 when extended. In particular, when pusher rod assembly 46 is pushed forward, piston rod 62 projects past the distal end 72 (FIG. 8) of the cutter 42, thereby clearing the hollow cutter 42 of any contents therein, such as tissue samples. Housing 18 further includes pusher stop 65 which limits the extent to which the pusher rod assembly 46 can be moved distally. The pusher rod assembly is guided by at least a holster track, defined by guide rail 75 and guide rail 77 (FIG. 1).

The other major component of the biopsy device is a cutter introducer removably mounted to holster 16. A cross section of a preferred embodiment of the biopsy introducer 14 is shown in FIG. 4. As discussed above, the cutter introducer 14 comprises a number of components, including hollow handle 24 and elongated sheath 26 having an aperture 30 formed at a distal end portion 32 of the sheath 26. The distal end 28 of sheath 26 preferably terminates in an atraumatic tip, such as a circumferential bevel. A proximal end portion 33 of the sheath 26 is fixed within the handle 24. An axial passage 25 is further defined by the hollow handle 24 and leads to sheath 26. Preferably the handle passage 25 is tapered so as to permit easier introduction of the cutter 42 or other instrument into the sheath 26. The handle 24 also defines an annular coupling socket 37 for rotatable mounting to coupling mount 48 of the biopsy instrument 12. In this embodiment, the socket 37 is configured to receive coupling mount 48 on holster 16 (FIGS. 2 and 3).

Also shown within the distal end portion 32 of sheath 26 thereof is tissue anchor 76. Tissue anchor 76 is optional and aids the operator in maintaining penetration control as indicated by depth marker 35. An externally applied nipple clamp (not shown) may be optionally employed to clamp or retain introducer sheath 26 within the nipple duct sphincter muscle, thereby also aiding in penetration control.

An enlarged view of the distal end portion 32 of the introducer is shown in FIGS. 5 and 6. Tissue anchor 76 comprises a hollow hub 78, flexible, outwardly biased tines 80 that extend from the hub 78, and a latch 82 which extends from the hub axially. The tissue anchor 76 is slidably and rotatably mounted within the distal end portion 32 of the sheath 26. Alternatively, tissue anchor 76 may be extended through the sheath 26 after an endoscopic viewing procedure has located the biopsy site. The anchor 76 can be partially or fully extendable through the open distal end 28 of the sheath 26, as desired. Latch 82 is configured to engage a distal end portion 86 of a retriever rod, which is discussed in further detail below.

Referring to FIG. 5, the tissue anchor 76 is shown in a retracted position. The tissue anchor 76 can be pushed partially through distal end 28 to extend the tines 80 until annular step 88 abuts beveled detent 90. The tissue anchor 76 may be pushed by any appropriate device, such as by an endoscope viewing assembly, push rod, or other instrument that is extendable through the sheath 26 to engage hub 78.

Referring to FIG. 6, the extent to which tissue anchor 76 can be extended through distal end 28 may be limited by hub 78 which includes an annular step 88, in cooperation with beveled detent 90 formed about the distal end portion 32. As the tines 80 are extended past the distal end 28, their outward bias causes the tines 80 to spread radially and engage the interior of the mammary duct (not shown). As such, the axial position of the sheath 26 within the mammary duct is secured. The hub 78, however, is sized to rotate relative to sheath 26. As such, the sheath 26 may be rotated about hub 78 within the mammary duct to reposition the circumferential orientation of aperture 30 even after the tissue anchor 76 has been engaged by manipulation of the handle 24 (FIG. 1). As will be discussed in further detail below, rotatable repositioning the aperture 30 permits collection of multiple tissue samples from the same region of a mammary duct.

Preferably, the annular step 88 and beveled detent 90 are contoured so that by application of additional force, the tissue anchor 76 can be urged past the distal end 28 of the sheath 26 and left in place as a marker for the biopsy site. Tactile feedback is provided to the operator by increased resistance from the interaction of annular step 88 and detent 90 when the anchor 76 is extended, but still within the sheath 26. Alternatively, tissue anchor 76 can be disengaged from sheath 26 by gently withdrawing sheath 26 from the biopsy site such that tissue anchor 76 is left behind still engaged with the mammary duct wall.

If it is desired to remove the anchor 76, preferably it is disengaged from the mammary duct by retraction into the sheath 26. In order to retract the anchor 76, a retriever rod 84 is introduced through the sheath 26. The retriever rod 84 includes a detent 85 for engaging the latch 82 extending from the hub 78 as shown in FIG. 7. The retriever rod 84 is then retracted from the introducer 14, thereby also retracting the anchor 76.

In order to obtain a tissue sample with the biopsy device 10 (FIG. 1), the cutter introducer 14 is first inserted into a mammary duct via a nipple orifice. The desired nipple orifice is first located through use of any means such as an illuminated nipple cup (not shown). A nipple orifice dilator or catheter (not shown) may be used to dilate the nipple orifice, if desired, to permit easier insertion of the introducer. An endoscope may be extended within the introducer to enable viewing of the biopsy site. When a desired mass of tissue is located, the anchor 76 is extended as described above, and as shown in FIG. 8. The hollow cutter 42 of the biopsy instrument is guided through the cutter introducer 14 and pushed towards the distal end portion 32 and the aperture 30. A tissue mass is received within the sheath 26 through the aperture or cut-out 30 at the distal end portion 32. The tissue mass can be urged into the aperture 30 by external pressure applied to the breast or alternatively with the aid of a vacuum, or by pressing the aperture against the desired biopsy area. The cutter motor 38 for driving the cutter 42 of the biopsy instrument can then be energized. Driven by motor 38, cutter 42 rotates and severs the portion of the tissue mass received within the sheath 26 as the distal end 72 of the cutter 42 travels across aperture 30. Preferably, the hollow cutter 42 receives the tissue mass within its interior. The biopsy instrument 12 is removed from the introducer 14 after the desired tissue sample is obtained, and the tissue sample is later expelled from the cutter 42 by piston rod 62 of the pusher rod assembly extending therethrough. Alternatively, the hollow cutter 42 may be operatively connected to a vacuum source for removal of the severed tissue sample through a central passageway defined by the hollow cutter 42.

An alternate embodiment of the tissue anchor and retriever rod are shown in FIG. 9. Anchor 91 has a configuration similar to the anchor discussed above, but includes a base 92 defining a threaded hole 93. Retriever rod 94 has a threaded distal end 95 that is threadably engageable with threaded hole 93. Anchor 91 can thereby extended to a desired degree and retracted by threadedly engaging retriever rod 94 with anchor 91 and extending or retracting the retriever rod 94.

To obtain multiple tissue samples from a biopsy site, and to discern the relative original locations of the tissue samples as part of the tissue analysis an azimuth marker is provided. To that end, and as illustrated in FIG. 10, an azimuth marker 98 having a plurality of circumferential marks 100, is provided and can be as part of a biopsy kit. Azimuth marker 98 is removably secured about a nipple 102, such as with a physiologically compatible pressure sensitive adhesive. The clinician notes how azimuthal indicators 34 and 36 align with circumferential marks 100 while the microendoscope is still positioned within introducer 14. The cooperation of the azimuthal indicators 34 and 36 and depth markers 35 establishes the location of the target tissue so that the microendoscope can be removed and the biopsy instrument 12 inserted. Utilizing the procedure discussed above, a tissue sample is obtained. As part of the procedure, the practitioner aligns the distal azimuthal indicator 34 and proximal azimuthal indicator 36 with a mark on the azimuth marker 98 and notes the indicator position. After a tissue sample is excised by the cutter 42, the biopsy instrument 12 is disengaged from the biopsy introducer 14. The practitioner extends the pusher rod assembly 46 by forwardly moving push rod handle 63, and thereby causing piston rod 62 (FIG. 8) to pass beyond the distal end of cutter 42 and eject the severed tissue sample. The tissue sample or samples may be collected on a collection tray having multiple recesses or numbered slots for tracking the source of the tissue sample. The biopsy instrument 12 can then be reinserted into the introducer 14, which is still held in place at the biopsy site by the tissue anchor 76, and rotated such that distal indicator 34 and proximal indicator 36 are aligned with a circumferential mark on azimuthal marker 98 different than that for prior tissue samples. In so doing, the aperture at the distal end portion of the introducer is repositioned to accept a tissue mass from a position adjacent to or near the previously excised tissue mass. The cutter then excises and retains a portion of this particular tissue. This sampling process is repeated as desired. For example, the practitioner can obtain tissue samples by aligning the distal indicator 34 and proximal indicator 36 with successive circumferential markers in a clockwise direction. Alternatively, multiple tissue samples can be obtained without retracting the biopsy instrument 12 from the introducer 14. In this case, the aperture 30 (FIG. 8) is positioned and the cutter 42 is rotated by the cutter drive motor 38 and passed across the aperture 30, which is then rotatably repositioned and the cutter is again rotated and passed across the newly positioned aperture 30. In so doing, multiple tissue samples are held within the hollow cutter 42. The cutter 42 is then removed and the multiple tissue samples ejected by the pusher rod assembly. As discussed, after the desired tissue samples are obtained, a retriever rod can be used to retract the anchor, and thereby, permit retraction of the introducer. If desired, the rod 64 of the pusher rod assembly may also serve as the retriever rod.

Another preferred embodiment of a biopsy device is shown in FIG. 11. Biopsy device 210 is comprised of a biopsy instrument 212 and a cutter introducer 214 removably carried by the biopsy instrument 212 and having hollow elongated sheath 226 mounted to handle 224. The cutter introducer 214 is essentially the same as described in the previous embodiment.

The biopsy instrument 212 comprises a holster 216, a housing 218 that is slidably and reciprocably received in holster 216, and a hollow elongated cutter 242, slidably received within elongated sheath 226 of cutter introducer 214. An ejector assembly 261 is further provided, which comprises a rocker arm, such as ejector handle member 263, a hinge member 267, and a barrel member 269. The barrel member 269 further defines a passageway 271 including a collar portion 272. The ejector assembly 261 further comprises an endoscope 262 having an adapter, such as a Tuohy fitting 276, that removably secures the endoscope to the collar portion 272 of the passageway 271. Also provided is an ejector assembly coil spring 266, which is biased against distal movement of the ejector assembly 261 towards the cutter introducer 214. Since the endoscope 262 is secured within the ejector assembly, its movement corresponds to the movement of ejector assembly 261. Operatively connected to the passageway 271 is a removable port member 273, through which solution, such as irrigation liquids may be introduced. Port member 273 is also suitable for providing a conduit for a suctioning device. A return spring, such as coil spring 256 is also provided between the housing 218 and the holster 216. Also, an on-off switch, such as button switch 245 is provided, which when actuated causes a motor to rotate cutter 242 such as described above.

As shown, the ejector assembly handle 263 is engaged with end cap 222, when the ejector assembly 261 is in a forward position thereby acting as a detent member. The endoscope 262 is also positioned such that its distal end 275 is extended proximate to or beyond the distal end 277 of the cutter 242. By positioning the endoscope 262 proximate the distal end 277 of the cutter 242, the practitioner is able to view the biopsy site in real time up to the time the cutting operation takes place.

When the practitioner is ready to begin cutting, tissue is urged through the window 230 by manipulating the patient's breast. In order to provide a collection reservoir 279, the endoscope 262 is first retracted as shown in FIG. 12. In this embodiment, the ejector assembly handle 263 is disengaged from the end cap 222 such that the ejector assembly coil spring 266 urges rearward movement of the ejector assembly 261. Accordingly, the endoscope 262 is retracted such that reservoir 279 is created in the distal end portion of the cutter 242. As discussed above, excised tissue may be collected in this reservoir 279. One benefit of the present configuration is that a practitioner can retract the endoscope 262 by fingertip control by releasing the ejector handle 263 as described.

Shown in FIG. 13 is another embodiment of a biopsy device having an endoscope. In many respects, biopsy device 310 is similar to the biopsy device of FIGS. 11 and 12. For example, biopsy device 310 comprises an introducer 314 and an instrument 312 having an ejector assembly (not shown) comprising an endoscope 362. One difference is the detent member used for positioning the ejector assembly and endoscope 362. In this embodiment, a rotatable hub 380 having an arm member 382 is provided with end cap 322. Hub 380 further defines a passage 384 through which endoscope 362 is passed. As before, endoscope 362 is removably secured with the ejector assembly. As shown, the arm member 382 is positioned such that the ejector assembly handle 363 is pushed up against the arm member 382 by the internal ejector assembly coil spring (not shown). With the arm member 382 so positioned, the ejector assembly and its endoscope 262 are held in the desired position within the introducer 314. Also, the housing 318 is prevented from being moved relative to the holster 316. When the practitioner is ready to begin the cutting operation, the hub 380 and arm member 382 are rotated such that the ejector assembly coil spring causes the ejector assembly to retract the endoscope such as described with the previous embodiment.

Referring to FIG. 14, another optional feature of the present invention is to provide a hook 431 in window 430. Since the practitioner is able, with endoscope 462 to view the desired tissue passed through window 430, the practitioner is also able to secure the tissue with hook 431. The hook 431 better enables the practitioner to maintain the position of the desired tissue within the sheath 426 during the cutting process by the cutter 442 since the hook grasps the desired tissue as shown. In addition, hook 431 is utilized to pull tissue through window 430 into sheath 426. This is accomplished by engaging tissue with the hook 431 and pulling on the tissue, which urges the tissue into the sheath 426. It is preferred that in a 0.039 inch (0.09906 centimeter) diameter stainless tube having a wall thickness of 0.0025 inches (0.00635 centimeter) that the hook have a depth of between one-third and one-half the tube diameter, or in this example, 0.13 to 0.185 inches (0.3302 to 0.4699 centimeters). It is most desired that the hook depth be about one-half the tube diameter. The hook 431 readily grasps the soft duct wall and pulls tissue into the cutter window 430 and supports the tissue such that its position within the window 430 is maintained as the cutter 442 is advanced. As pressure is increased, the hook 431 either pierces the tissue and thereafter begins tearing it off or the tissue slips off the hook 431. Since the practitioner is able to view the biopsy site in real time with the endoscope 462, the practitioner is able to best determine the amount of pulling force to exert without tearing the tissue, and to see when to advance the cutter 442. The viewing capability of the endoscope with the cutter in position to be activated for the cutting procedure also provides the practitioner with great flexibility in the size of the sample taken. For example, if the practitioner wishes to take a relatively small sample, the hook 431 is merely utilized to grasp tissue. On the other hand, if a larger tissue sample is desired, additional pressure is utilized so the hook pulls more tissue within the window 430. Given the relatively small difference between the amount of pressure being exerted in these two situations, as discussed above, the real time visual inspection through the endoscope 462 allows such a procedure to take place.

While it has been found that a deeper hook depth is generally more advantageous, various factor constrain the hook depth, including the marginal strength of the material forming the introducer, the wall thickness, and the outside diameter of the tube. This is because the hooking process causes a shaft deflection which may cause the advancing cutter to catch the hook causing damage thereto. Therefore, as little shaft deflection as possible is desired, and the dimensions described above provide satisfactory results.

It is also preferred that the window 430 be relatively long. In the example being discussed of a 0.039 inch (0.09906 centimeter) diameter stainless tube having a wall thickness of 0.0025 inches (0.00635 centimeter), and hook depth of 0.13 to 0.185 inches (0.3302 to 0.4699 centimeters), it is preferred that the window have a length of greater than 0.197 inches (0.5 centimeter). The longer window 430 allows a desired amount of tissue to be pulled therein by hook 431.

Yet another type of sampling that is possible with the present biopsy device is shown in FIG. 15. In addition to the sampling by urging tissue through a window and excising this tissue as discussed thus far, the biopsy device may in some embodiments also act as a core type cutter. For example, the distal end 577 of cutter 542 can be urged beyond the distal end portion 532 of the sheath 526 to cut core samples of tissue. As shown, endoscope 562 can be utilized by the practitioner to view the coring procedure.

Preferably, the distal end 577 of the cutter 542 has an inner diameter that is 90% to 95% of inner diameter of the rest of the cutter 542. It has been found that a fully parallel cutter sometimes results in a core sample that remains attached to the patient. The reduced diameter distal end 542 creates a packing feature, which will tend to pull the tissue and tear away from the uncut end. In other words, after the cutter has cut tissue, the endoscope is advanced to slightly compact the tissue against the distal end within the cutter to aid in sample removal. Another alternative method is to insert a sharpened forward moving pin into the cutter after the core is cut by removing the endoscope. The moving pin acts to wedge the tissue sample within the cutter to aid in sample removal.

The foregoing descriptions are to be taken as illustrative, but not limiting. Still other variants within the spirit and scope of the present invention will readily present themselves to those skilled in the art. 

1. A biopsy device suitable for collection of a tissue sample from a biopsy site in a body lumen, the biopsy device comprising: a cutter introducer comprising an elongated, hollow sheath, the sheath rotatable about a longitudinal axis having a distal end portion and a proximal end portion, wherein the distal end portion defines an aperture for receiving a tissue mass, and a hollow handle about the proximal end portion of the sheath; a biopsy instrument comprising an elongated cutter for severing the tissue sample, received through the aperture, the cutter element being sized for removable insertion in the cutter introducer; and an endoscope, the endoscope being sized for removable insertion in the elongated cutter and having a distal end portion movably positionable proximate the aperture.
 2. The biopsy device of claim 1, wherein the cutter is motor driven and the motor is actuated by a switch.
 3. The biopsy device of claim 1, further comprising an ejector assembly, the ejector assembly including the endoscope which is suitable for ejecting the tissue sample from the cutter.
 4. The biopsy device of claim 3, wherein the ejector assembly further comprises a detent member to restrict axial movement of the ejector assembly relative to the biopsy instrument.
 5. The biopsy device of claim 4, wherein the detent member comprises a rotatable hub.
 6. The biopsy device of claim 4, wherein the detent member comprises a rocker arm.
 7. The biopsy device of claim 1, wherein the sheath further includes spaced depth indicators thereon.
 8. The biopsy device of claim 1, further comprising a port member suitable for permitting the introduction of a solution to the biopsy site.
 9. The biopsy device of claim 1, wherein the aperture comprises a hook portion.
 10. The biopsy device of claim 9, wherein sheath has an inner diameter and the hook portion has a hook depth in a range of ⅓ to ½ the inner diameter.
 11. The biopsy device of claim 9, wherein the aperture has a length greater than 0.197 inches (0.5 centimeter).
 12. A biopsy device suitable for collection of at least one tissue sample from a biopsy site in a lumen, the biopsy device comprising: a holster; a housing reciprocably mounted with the holster; a cutter drive motor in the housing; a power source operably associated with the cutter drive motor; a switch operably associated with the motor and the power source for energizing the cutter drive motor; a hollow cutter driven by the cutter drive motor and rotatably mounted in the housing; an endoscope removably mounted to the housing and slidably receivable within the hollow cutter; and a coupling mount on the holster for removably receiving a biopsy introducer, the introducer comprising an elongated, apertured hollow sheath having a distal end portion and a proximal end portion, wherein the distal end portion defines an aperture for receiving the tissue sample.
 13. The biopsy device of claim 12, wherein the power source is situated within the housing.
 14. The biopsy device of claim 13, wherein the power source is a battery.
 15. The biopsy device of claim 12, wherein the coupling mount is a boss terminating in an distal, radially outwardly extending flange.
 16. The biopsy device of claim 12, further comprising an ejector assembly, the ejector assembly including the endoscope which is suitable for ejecting the tissue sample from the cutter.
 17. The biopsy device of claim 16, wherein the ejector assembly comprises a detent member to restrict axial movement of the ejector assembly relative to the housing.
 18. The biopsy device of claim 17, wherein the detent member comprises a rotatable hub.
 19. The biopsy device of claim 17, wherein the detent member comprises a rocker arm.
 20. A biopsy device suitable for collection of at least one tissue sample from a biopsy site in a lumen, the biopsy device comprising an introducer and an instrument: the instrument further comprising: a holster and a housing reciprocably mounted to the holster; a cutter drive motor in the housing; a power source operably associated with the cutter drive motor, the cutter drive motor and power source being operatively connected to a switch for energizing the cutter drive motor; an elongated hollow cutter driven by the cutter drive motor and rotatably mounted in the housing; an ejector assembly suitable for ejecting the tissue sample from the cutter, the ejector assembly including an endoscope piston removably mounted with the housing and slidably receivable within the hollow cutter; and a coupling mount on the holster for removably receiving the introducer; the introducer further comprising an elongated, hollow sheath having a distal end portion and a proximal end portion, wherein the distal end portion defines an aperture for receiving the tissue sample, the aperture comprising a hook portion, the sheath suitable for removably receiving the cutter therein.
 21. The biopsy device of claim 20, wherein sheath has an inner diameter and the hook portion has a hook depth in a range of ⅓ to ½ the inner diameter.
 22. The biopsy device of claim 20, wherein the aperture has a length greater than 0.197 inches (0.5 centimeter). 